Home and Community-Based Waivers: Opportunities for Community Living for ABI Survivors

Transcription

1 Home and Community-Based Waivers: Opportunities for Community Living for ABI Survivors BIA-MA Brain Injury Conference March 30, 2017 Amy Bernstein Director, Community Based Waivers MassHealth Dorothée Alsentzer Manager, Community Based Waivers MassHealth

2 Overview: HCBS Waivers Alternative LTSS programs for individuals who otherwise require care in a facility 2

3 HCBS / 1915(c) Waivers CMS can waive certain requirements that otherwise apply to the Medicaid program, giving the state flexibility to define: The target group of Medicaid beneficiaries to be served, subject to certain requirements The maximum number of participants who may be served in a given HCBS waiver program The services available to the waiver target group (in addition to what is already available through the Medicaid State Plan) 3

4 HCBS Waiver Operations MassHealth Receives authority from CMS to administer each HCBS waiver Responsible for required cost neutrality reporting EOHHS agencies, or their agents, have day-to-day responsibility for waiver oversight and operations Level of Care (LOC) evaluation Waiver Plan of Care (POC) Person-centered planning Case management/service coordination Incident oversight and resolution Waiver quality monitoring, measurement, and reporting 4

5 Requirements For All HCBS Waivers Waiver Participants must be financially eligible and Require a facility level of care (LOC) Have an ongoing need for, and receive waiver services at least once a month Be able to be safely served in the community with available waiver and State Plan services Waiver services must be authorized through a personcentered waiver Plan of Care (POC) 5

6 Waiver Plan of Care (POC) Person-centered planning process results in a POC that Acts as the authorization for waiver services Specifies amount, frequency, and type of provider for each waiver service the participant will receive Service plans must be reviewed and updated At least annually, and Whenever necessary due to a change in the participant s needs or circumstances 6

7 Overview: Waiver Eligibility 7

8 Waiver Eligibility Two parts to waiver eligibility Clinical eligibility is determined by the waiver operating agency or its agent Clinical Eligibility Determinations Waiver(s) DDS Adult ID Waivers Children s Autism Waiver Agency/Agent DDS DDS Financial eligibility is determined by MassHealth Both types of eligibility must be reviewed annually TBI Waiver Frail Elder Waiver ABI Waivers MFP Waivers MRC ASAPs UMass UMass 8

9 Waiver Financial Eligibility HCBS Waiver participants must be eligible for MassHealth Standard Special financial eligibility guidelines apply for HCBS adult waivers Applicant s income 300% SSI Federal Benefit Rate (FBR, which is currently $2,205 a month) Countable assets of applicant $2,000 Countable assets of applicant s spouse $120,900 9

10 Massachusetts HCBS Waivers 10

11 10 Massachusetts HCBS Waivers TBI Traumatic Brain Injury DDS-Intensive Supports DDS-Adult Supports DDS-Community Living Children s Autism Spectrum Disorder ABI-RH Acquired Brain Injury Residential Habilitation ABI-N Acquired Brain Injury Non-residential Habilitation MFP-RS Money Follows the Person Residential Supports MFP-CL Money Follows the Person Community Living FEW Frail Elder Waiver 11

12 ABI/MFP Waiver Eligibility To qualify for the waiver, an individual must... Have an ABI* that was sustained at age 22 or older ABI Waivers MFP Waivers Be a disabled adult or be aged 65 or older Have been living in a facility for at least 90 days Meet clinical level of care requirements Need available waiver services Qualify financially for MassHealth Standard Be able to be safely served in the community * Some examples of ABIs that qualify are brain injuries resulting from stroke, brain trauma, infection of the brain, brain tumor, or anoxia. Dementia-type conditions alone do not qualify. 12

13 ABI Waivers For individuals aged 22 and older ABI Non-Residential Habilitation (ABI-N) Waiver (MRC) Participants do not need 24 hour supports or supervision MRC Case Managers coordinate waiver services Includes a limit of 84 hours per week of in-home supports, e.g., personal care services, homemaking, etc. ABI Residential Habilitation (ABI-RH) Waiver (DDS) Participants require supervision and staffing 24/7 and receive services in provider-operated and staffed settings DDS Service Coordinators coordinate waiver services 13

14 MFP Waivers For individuals aged 18 and older MFP Community Living (MFP-CL) Waiver (MRC) Participants do not need 24 hour supports or supervision MRC Case Managers coordinate waiver services Includes a limit of 84 hours per week of in-home supports, e.g., personal care services, homemaking, etc. MFP Residential Supports (MFP-RS) Waiver (DDS) Participants require supervision and staffing 24/7 and receive services in provider-operated and staffed settings DDS Service Coordinators coordinate waiver services 14

15 Recent Changes to the MFP Waivers Both MFP Waivers are continuing! MFP Demonstration is winding down Enrollment closed 8/31/16 Transitions ended 12/31/16 Corresponding updates to the MFP Waivers include Remove Demonstration-related eligibility language Add Transitional Assistance services formerly provided through the MFP Demonstration 15

16 Frail Elder Waiver Eligibility To qualify for the waiver, an individual must... Be a disabled adult aged or be aged 65 or older Require a nursing facility Level of Care Need available waiver services Qualify financially for MassHealth Standard Be able to be safely served in the community FEW Waiver The FEW serves individuals who are transitioning out of a facility setting and those who already live in the community 16

17 Frail Elder Waiver (FEW) For individuals aged 60 and older Operated by the Executive Office of Elder Affairs (EOEA) Aging Services Access Points (ASAPs) conduct Level of Care determinations, provide case management, and manage waiver provider enrollment and oversight Serves individuals living in their own home or with family, but not in provider-operated residential settings Key services include homemaker, personal care, home-delivered meals, companion, medication dispensing system and transportation FEW participants can choose to enroll in SCO to receive all waiver and state plan services 17

18 Choosing and Applying for an HCBS Waiver 18

19 Where does the applicant reside? The Waiver serves individuals who... ABI Non-Residential Habilitation ABI Residential Habilitation MFP Community Living MFP Residential Supports...are being discharged from a facility...already live in the community Frail Elder Waiver 19

20 Agency Affiliation Past or current affiliation with the agency providing case management for the waiver may help applicants to select the waiver that will best meet their needs HCBS Waiver ABI-N ABI-RH MFP-CL Case Management Agency Massachusetts Rehabilitation Commission (MRC) Department of Developmental Services (DDS) MRC MFP-RS FEW DDS Aging Service Access Points (ASAPs)/ Senior Care Options (SCO) Plans 20

21 Resources for Individuals Considering HCBS Waivers ABI and MFP Waivers State agency case managers/service coordinators discuss waiver opportunities and assist in filling out the application form Peer/family outreach volunteers share personal stories about making the decision to enroll and transitioning to the community Fact Sheet for Professionals helps facility administrators and staff to better understand the ABI/MFP Waivers Frail Elder Waiver Local ASAP SHINE counselors Long Term Care Ombudsman 21

22 What happens after submitting an ABI or MFP waiver application form? MassHealth financial eligibility determination Clinical eligibility assessment and determination Eligible applicant assigned to MRC or DDS Case Manager or Service Coordinator Transition planning and development of a waiver plan of care Transition to community and initiation of home- and community-based services 22

23 Waiver Services NOTE: Not all waiver services are included in every waiver 23

24 Residential Services Residential Habilitation Care, supervision, and skills training in a provider-operated group setting (typically 4-5 residents) Shared Living Participant lives with a caregiver who provides skills training, personal care assistance, and household tasks with oversight by a provider agency Assisted Living Services Participant resides in a certified assisted living residence that includes assistance with personal care, homemaking, meals, and access to 24-hour on-site staff 24

25 Day & Employment Services Day Services Structured, site based, group programs provide socialization, assistance with functional and prevocational skills, etc. Prevocational Services Prepare a participant for paid or unpaid employment, e.g. attention span, task completion, attendance Supported Employment Services Training and ongoing support to maintain paid employment 25

26 Additional Waiver Services In-Home Supports Personal care Homemaker, chore, laundry, and grocery shopping services Home delivered meals Skills training services Individual Support and Community Habilitation Peer support Occupational, Physical, and Speech Therapies Transportation services 26

27 Additional Waiver Services Home Modifications Vehicle Modifications Assistive Technology and Specialized Medical Equipment Orientation and Mobility Services Transitional Assistance Services Set-up expenses for individuals moving from a nursing facility or other facility to the community, including essential household furnishings, security deposits, etc. 27

28 Questions? 28

29 Contact Information For ABI and MFP Waivers For questions about the ABI or MFP Waivers or the application process Call the UMass Medical School ABI/MFP Waiver Unit / TTY To arrange an in-person visit by a state agency case manager and/or peer/family outreach volunteer for individuals considering an ABI or MFP waiver Call Mass. Rehabilitation Commission (MRC)

30 Helpful Links Application forms for ABI and MFP Waivers ABI-RH: English / Spanish MFP-RS: English / Spanish ABI-N: English / Spanish MFP-CL: English / Spanish ABI-RH: Michael Waiver Participant Videos ABI-N: Susan Money Follows the Person (MFP) Waivers Acquired Brain Injury (ABI) Waivers Frail Elder Waiver (FEW) (call the local ASAP) 30